This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The goal of this proposal is to develop a multidisciplinary cleft and craniofacial disorders program where children in Hawaii can be followed from birth through adulthood. The research goals of this clinic stem from the opportunity to study a unique pediatric population. At no time in recent history has every cleft lip/palate patient in Hawaii been serviced within the same multidisciplinary team. The general practice has been primary physician referral to one of several adult plastic surgeons for initial repair and reconstruction, with fragmented outpatient follow-up. Dentistry and orthodontics are often not included in these referrals. Although many are followed by a nurse case manager and social worker from the DOH Special Health Needs Division, many are lost in the system and receive inadequate hearing and speech follow-up. It is hypothesized that the formation of this clinic will result in improved global medical care for these infants and children, beginning with improved growth and development via aggressive feeding evaluations and rehabilitation care. Improved hearing screening and treatment of hearing loss will be included, with speech and language evaluation and therapy when needed. These together should improve cognitive outcomes in these children as measured in neurodevelopmental assessments in the first two years of life. With continued care these children will have improved speech and language skills, improving integration into mainstream school systems. This will lead to improvements in school outcomes, function in daily living and self-concept as the child ages, as measured by a Pediatric Health-Related Quality of Life Inventory.